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“We seek to identify what works, what doesn’t and why, and implement changes in our programs to optimize … that information.”
— USAID Administrator Rajiv Shah
IMPROVING HIV AND AIDS PROGRAMMING THROUGH THE TRANSLATION OF RESEARCH TO PRACTICE
Implementation science focuses on how to improve the uptake, translation and implementation of research into common practices. These efforts build the evidence base for HIV programs and maximize the impact of HIV and AIDS investments around the world. Organizations work to disseminate the results gathered through research, helping countries strengthen their efforts to prevent new infections and save lives.
Implementation science is important because it can:
- Conduct research and program evaluations to improve HIV prevention, care and treatment programs in countries most affected by the HIV epidemic.
- Conduct research and evaluations of HIV and AIDS treatment, care and support and prevention of mother-to-child transmission (PMTCT) of HIV service delivery programs in developing countries.
- Monitor, evaluate and address gaps in gender-based violence prevention programming.
- Address HIV and AIDS service delivery challenges for programs under the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).
- Develop and demonstrate approaches to translate efficacious HIV and AIDS biomedical prevention methods and service delivery practices into real world settings.
- Expand data collection and analysis to improve program implementation.
Behavioral, social and structural approaches to HIV prevention
While there have been significant advances in demonstrating the effectiveness of several HIV prevention interventions, questions remain about the strength of evidence on the connection between behavioral and structural interventions and reductions in HIV incidence. A stronger evidence base is needed to understand how programmatic interventions impact sexual behaviors and ultimately reduce HIV incidence.
HIV prevention, care and treatment for key populations
In order to effectively respond to the global pandemic, the need to tailor and target recent advances in HIV prevention, care and treatment to ensure they are also effective for key populations (or most-at-risk populations) remains critical. Although a number of interventions have been shown to be effective, more studies are needed on how to address structural, behavioral and biomedical factors in order to overcome barriers to reach marginalized populations.
Gender norms, roles and relationships
Despite some indication of effective strategies to address gender, significant gaps exist. Evidence is needed to determine how best to measure and evaluate gender-equitable programming. For female-initiated HIV prevention methods, specifically the female condom, additional information is needed to understand the barriers to their wide-scale acceptability and utilization.
Positive health, dignity and prevention (PHDP)
These principles support HIV-positive people lead healthier lives and facilitate goals of preventing further transmission within an environment of shared responsibility with their community. Further evidence is needed to evaluate the impact of integrating PHPD interventions into care and treatment services for both antiretroviral-eligible and pre-antiretroviral patients and clients. Additional information is also needed to understand how PHPD principles can be integrated through delivery of biomedical, behavioral and structural services across both clinic and community settings.
Health systems strengthening
To address various health system challenges, innovative program models are being developed to integrate new technologies and approaches, such as electronic and mobile health (eHealth and mHealth), which also include financing and payment mechanisms, such as provider payment systems and performance- or results-based incentive systems.
Nutrition assessment, counseling and support (NACS)
This is a critical component of HIV and AIDS care and treatment. HIV and malnutrition interact in a vicious and progressive cycle. However, to date, there has been limited evaluation of the impact of NACS on people living with HIV and AIDS and affected families. With regard to clinical outcomes, adherence and retention in care and treatment and improved household resilience and food security, more study is needed.
CURRENT PROGRAMMATIC HIGHLIGHTS
Implementation Science Research to Support Programs under PEPFAR
In 2012, USAID awarded over $21 million to support eight studies in eight countries. The studies aim to answer critical questions across a range of HIV technical area-specific program topics, as well as about how to strengthen the integration of programs across the prevention, care and treatment continuum.
Supporting Evaluation and Research to Combat HIV/AIDS (Project SEARCH)
Through the Project SEARCH indefinite quantity contract, USAID carries out HIV and AIDS program research and evaluations to improve coverage, quality and effectiveness of HIV and AIDS prevention, care and support and treatment programs. Core-funded task orders include the following:
The Research to Prevention (R2P) project, implemented by Johns Hopkins University, supports research to identify the most effective interventions for preventing HIV and improving HIV prevention programs. R2P seeks to achieve this goal by conducting applied research and program evaluation, promoting the utilization of data in program design and building local research capacity.
The HIVCore project, led by the Population Council in partnership with the Futures Group, the Elizabeth Glaser Pediatric AIDS Foundation and the University of Washington, supports research that seeks to improve the efficiency, effectiveness, scale and quality of HIV and AIDS treatment, care and support, and PMTCT programs by conducting operations research and focused evaluations and promoting research findings.
The Gender-Based Violence (GBV) Program Evaluation, implemented by the Futures Group, aims to identify and address gaps in GBV prevention and service delivery programming through intensive monitoring and evaluation of GBV programs. It provides tools and methods for evaluating promising service delivery and community-based intervention models for GBV prevention and related HIV outcomes.
Last updated: October 21, 2013